Abstract
Background Fluoroscopy-guided blockade of the greater occipital nerve (GON) is an accepted method for treating the symptoms of cervicogenic headaches (CGHs). However, the spread patterns among different injectate volumes of fluoroscopy-guided GON blocks are not well defined. Objective A cadaveric study was established to determine the spread patterns of different volumes of dye injectate within a fluoroscopic GON block. Study Design. Cadaveric study. Setting. Xingtai Institute of Orthopaedics; Orthopaedic Hospital of Xingtai. Methods 15 formalin-fixed cadavers with intact cervical spines were randomized in a 1 : 1 : 1 ratio to receive a fluoroscopy-guided GON injection of a 2, 3.5, or 5 ml volume of methylene blue. The suboccipital regions were dissected to investigate nerve involvement. Results The suboccipital triangle regions, including the suboccipital nerves and GONs, were deeply stained in all cadavers. The third occipital nerve (TON) was stained in 7 of 10 administered 2 ml injections and in all the 3.5 ml and 5 ml injections. Compared to the 3 ml injectate group, the 5 mL cohort consistently saw injectate spreading to both superficial and distant muscles. Limitations. Given that cadavers were used in this study, cadaveric soft tissue composition and architecture can potentially become distorted and consequently affect injectate diffusion. Conclusions A 3.5 or 5 mL fluoroscopy-guided GON injection of methylene blue successfully stains the GON, TON, and suboccipital nerves. This suggests that such an injection would generate blockade of all three nerve groups, which may contribute to the efficacy of the block for CGH. A volume of 3.5 ml may be enough for the performance of a fluoroscopy-guided GON block for therapeutic purposes.
Highlights
A cervicogenic headache (CGH) is a well-recognised headache syndrome
Greater occipital nerve (GON) blockade procedures are commonly performed for CGHs, which have a dual role in both supporting a diagnosis and providing pain relief
As a result of a localised and painful pressure point at the greater occipital nerve, a confined injection of corticosteroid and local anaesthetics is classified as 1B + for the management of CGH when conservative treatments fail [5]. e suboccipital compartment injection was introduced in 1980 by Racz et al [6] and has been subsequently recommended by others. e fluoroscopy-guided GON block technique is an accepted treatment method for the symptoms of CGHs and is superior to the classical GON technique [7]
Summary
Fluoroscopy-guided blockade of the greater occipital nerve (GON) is an accepted method for treating the symptoms of cervicogenic headaches (CGHs). The spread patterns among different injectate volumes of fluoroscopy-guided GON blocks are not well defined. A cadaveric study was established to determine the spread patterns of different volumes of dye injectate within a fluoroscopic GON block. 15 formalin-fixed cadavers with intact cervical spines were randomized in a 1 : 1 : 1 ratio to receive a fluoroscopy-guided GON injection of a 2, 3.5, or 5 ml volume of methylene blue. Given that cadavers were used in this study, cadaveric soft tissue composition and architecture can potentially become distorted and affect injectate diffusion. A 3.5 or 5 mL fluoroscopyguided GON injection of methylene blue successfully stains the GON, TON, and suboccipital nerves. A volume of 3.5 ml may be enough for the performance of a fluoroscopy-guided GON block for therapeutic purposes
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